Cm. Segeren et al., Vincristine, doxorubicin and dexamethasone (VAD) administered as rapid intravenous infusion for first-line treatment in untreated multiple myeloma, BR J HAEM, 105(1), 1999, pp. 127-130
We examined the feasibility of achieving a rapid response in patients with
previously untreated multiple myeloma by administering vincristine 0.4mg an
d doxorubicin 9 mg/m(2) as a rapid intravenous infusion for 4d together wit
h intermittent high-dose dexamethasone 40 mg (VAD) for remission induction
treatment in patients who were scheduled to receive high-dose therapy. 139
patients (86 male, 53 female; median age 53 years, range 32-65 years; Durie
& Salmon stage IIA: 42, IIB: one, IIIA: 89, IIIB: seven) were included in
a prospective multicentre study in which VAD was administered as remission
induction treatment and was followed by intensified treatment. The response
was evaluated according to the criteria of the Eastern Cooperative Oncolog
y Group (ECOG). The results of treatment were evaluable in 134 patients. Fi
ve patients died before evaluation. 86 patients (62%) achieved a partial re
sponse (PR) and seven patients (5%) achieved a complete response (CR), whic
h equates to a response rate of 67%. The main side-effect was mild neurotox
icity, which was observed in 18% of the patients. Fever or infections were
reported in 27% of the patients. VAD administered as an outpatient regimen,
based on rapid intravenous infusion, is an effective induction regimen for
untreated myeloma with a 67% response rate and acceptable toxicity.